Tales From Behind The Mask - Operating Room Nursing How To

An old OR nurse once told me that any good OR nurse always carries scissors in his/her pocket. While I make use of my scissors daily, there are other factors that are vital to being a great OR nurse. Nurses Announcements Archive Article

Updated:  

Tales From Behind The Mask - Operating Room Nursing How To

One of the first things that any aspiring OR nurse needs to do is find a good pair of shoes...for me, I'm always on the hunt for the "perfect" shoe. This has led to me having a nursing shoe museum in my locker. I open it and nine times out of ten, I'm greeted with an avalanche of footwear.

Currently, I have two pairs of Danskos, two pairs of Crocs(one with holes, one without) a pair of Nursemates and a pair of Red Cross shoes. I try to rotate them and wear all of them except for one pair of Danskos, which sit in my locker and make me feel guilty every time I look at them. There went $100 down the drain! At least my scrubs are provided by the hospital, so I have a little bit of leeway with my shoe sickness. The shoes are important because in the OR, I spend the majority of the day on my feet. I also have to run for items that the surgeon decides he or she needs all of a sudden. I'm seriously considering asking the makers of Heelies(sneakers that have roller skate wheels on the bottom) to make a nursing shoe.

This running amuck in the OR is probably the aspect of the job that most people equate with being an OR nurse. While it's a huge part, it's not the most important part. The most vital part of OR nursing is being a patient advocate. I have to admit, I tend to get peeved when those outside the OR state that OR nurses don't have to like patients because "the patients are unconscious anyway". Even worse, they think we don't do any patient care. Nothing could be further from the truth. Having surgery tends to bring out the most vulnerable aspects of a patient's personality. We have to gain our patient's trust in a short span of time(about 10 minutes) and I've had to use all those "theraputic communication techniques" that you learn about in nursing school. Sometimes they backfire though! One time, as a squeaky new OR nurse, I had a patient who was seriously depressed and had anxiety issues.

The holding room nurses said she had been very weepy on and off in the time she had been there. I introduce myself and I ask her all the usual questions(allergies, NPO status, any previous surgery?) and we seem to be getting along nicely. She even smiled once or twice. I was trying to keep her distracted since she was anxious, so I start asking her "get to know you" type questions. Everything was going fine until I asked her if she had any pets at home. She bursts out crying and told me that her cat "Snowy" recently got hit by a car. I mean, she was practically in hysterics. One minute, I think I'm doing a pretty good job and was proud of myself, the next, I'm running to get her tissues and assuring her that if animals do go to heaven, Snowy is most certainly there. Sheesh, took me a while to live THAT one down. 

In my hospital, we do an ID of the patient with anesthesia and the attending and this process is not up for negotiation. Most of the doctors are good about this, but I've had to stand my ground with a couple to make sure this gets done. I help anesthesia intubate the patient and I try to provide emotional support for the patient while they're going to sleep(although since the Snowy incident, I leave pet questions out of my repertoire!). I then help position the patient, and this is important, since you can cause damage to a patient if they're not positioned properly. Often, the surgeon wants the patient to have a Foley , so I put that in-I had a great dread of female Foleys for a good month or two. I've since learned that the OR light can be your best friend when trying to find that elusive female urethra and also not to be shy about asking someone to don gloves and help "retract" the lady parts.

I put a grounding pad on the patient(for the electrocautery) and I make sure they have a safety strap securing them to the bed. In my OR the residents prep, and sometimes they'll take the belt off or it will shift. This means that I have to pay attention and fix the belt if need be. The patient is then draped by the doctor and scrub. I plug things in and make sure the scrub has everything he or she needs to get started.

I pride myself on not starting my charting until everything at the field is settled. We have computerized charting and while I am computer savvy for the most part, I swear these systems were made by someone who never stepped foot into an OR. Documentation is important, yes, but my ultimate priority is that patient. I admit, more than a few times I've been saying some very naughty words under my breath while charting and fantasized about committing bodily harm against the person who thought of bringing computerized charting into our OR. Then again, I'd probably end up having to take care of them, so why bother!

I was a scrub tech for a few years so I'm one of those nurses that "lurks" outside of the field. I do this for a couple of reasons. First of all, I feel that it's my job to keep track of what's going on and second, I'm nosy and feel left out sometimes. I think the techs like it because they don't have to flag me down frantically if they need something and most surgeons like to teach and show what they can do. I can also make sure sterility is maintained-most of the time, it's usually the light handles that get contaminated by a tall resident/surgeon who hits it with his/her head. When I have tall docs in my room, I bring an extra set of light handles in.

I give medications to the tech, call the blood bank for blood, check the blood with the anesthesiologist/CRNA, and answer pagers if the doctor is on call. I hate those freakin' pagers with a passion and have had to restrain myself from flushing them down the nearest hopper. I hear that some places make physicians leave them at the desk and can only dream of such a marvelous place!

The counts that we do to make sure no suture, sponges, or instruments are left in the patient are one of the most crucial things we do for that patient. We do three counts for the most part...one before incision is made, one at closing and a final count when we're on skin. I work in Ortho, so we don't count instruments. I've had to butt heads with doctors who were being difficult when told of an incorrect count (ie. they keep closing). Most times, the item is found in the folds of drapes or on the floor, but on a few occasions, it's been in the patient. I have to say, the majority of the surgeons are grateful if you've kept them from leaving something inside the patient.

After the procedure, we move the patient back on to the stretcher, and the anesthesiologist/CRNA and myself take the patient to PACU. I give report and tell the PACU nurse anything unusual that happened, if any meds were given and how much, mention drains and dressings.

I know in my above description, it sounds unlike a lot of nursing jobs out there, and can seem very technical, but everything we do is for that patient. If these things are done poorly or not at all, it can severly impact the patient's recovery and in some cases, survival. An OR nurse can't be afraid to disagree with the surgeon or anesthesia if policies aren't being followed. I've taken to saying that if I don't butt heads with someone at least once a shift, then I'm not doing my job right.

It seems to me that a good OR nurse has to assume many roles and be at various times, a psychologist, a computer specialist, a mechanic, a gopher, and an advocate. You have to have compassion, curiosity, a good set of eyes and ears, and stamina. A strong stomach doesn't hurt either. Some people have asked me if they need previous experience to be successful in the OR, either med/surg or some other specialty.

I don't think so-to me, the OR environment is one in which enthusiasm and a willingness to learn will take you far. Those things, and a good pair of shoes.

2 Votes
GadgetRN71

About GadgetRN71, ASN, RN

1,840 Posts

Share this post

Specializes in cardiac, diabetes, OB/GYN.

As a labor and delivery room with a fear (performance anxiety) over learning the OR , I have to say it was wonderful to "see" the OR through the eyes of a nurse I haven't intentially awakened and irritated by calling him or her in for a stat csection. This is a great insight and something I cannot wait to share with my fellow labor and delivery nurses because we are all going through scrubbing and circulating right now officially (we have all been there in a hurry with our hearts beating out of our chests), and I totally appreciated and enjoyed this article..Thank You and well done! Martha

0 Votes

you sound like you are an amazing OR nurse. I have had 12 surgeries and would love for you to be my nurse.

0 Votes
Specializes in Emergency Room.

Thank You! I graduate from nursing school in May with my BSN, and I am planning on pursuing a carrer in the OR. You have given me hope that, as a new nurse I can suceed in the OR environment. I have always been so facinated by the OR and surgery in general. I plan on applying for a perioperative internship at the local university hospital, where they teach nurses to scrub and circulate. When I share my goal with other nurses, they always say, "you'll never get a job there as a new grad, you'll have to have some med-surg experience." That always irritates me to no end. :angryfire I have no intention, what so ever, on going into the Med-Surg field. I feel like my heart belongs in the OR. My main goal is becoming a first assisting RN. Do you have any thoughts on that? Have you had any experiences with them?

Thank you again for your story. It was such a unique, and often untold look at nursing. :yeah:

0 Votes

OR works is adventurous.Truly it needed a very good pair of dancing shoes,( i said dancing shoes because when i worked as circulator as if you are dancing)to a different tunes of forceps clanging, noisy vents,suction galloping and group of the team chanting or discussing..

But, being one, it takes a lot of quick mind and body to do your job.And most, butt heads are always there in the field, thats absolutely true...

In all cases, Patient care and concern is always the first.

0 Votes
Specializes in OR, ER, TRAVEL, SURGICARE, WOMENS HOSP.

Witchy, I too was a CST before RN and worked 25 years in surgery. I also worked 5 years for plastic surgeon, then traveled for 2. Couple of years at Surgery Center, and one at a Women's Hospital. I now am 5 years and counting in ER in a small hospital. As you say shoes are a big deal in surgery and I never heard anyone put it quite so well. Surgery gets in your blood (no pun intended!) You may find this interesting but I got the idea when I went out to eat at a restaurant named Captain D's. Whenever a patron walked through the door all of the workers on the front line stopped for a second and spoke a friendly "HEllo", then proceeded with the task at hand. So... as a surgical tech I make it my practice when a patient entered the OR to turn from my backtable and just give a kind "HELLO". then turn and go about my business. The RN on the case thanked me for it and thought it was a good idea. It has been a long time since I worked there but from what I understand the practice is still carried on! I know it has been awhile since you posted this article but I just joined and anything about surgery catches my eye. If you see this let me know.

0 Votes

Beccarner, yes we still do that. In the OR, I work for in Alberta, Canada, we scrub and circulate. Whenever, I scrub, I always take a few seconds and say hello to the patient and when I bring the patient in I always make a point of introducing everyone in the room.

Witchy, you are bang on and funny about the OR. I love OR nursing and would not go anywhere else and if I do then I probably left nursing all together.

0 Votes
Specializes in OR, ER, TRAVEL, SURGICARE, WOMENS HOSP.

AGDMARIE, It is crazy for your institution to think that you should have med/surg experience before you can work in the OR! These two places are differant as night and day. The only similarities are post-op patients from the OR. You can learn about where there incisions are and learn about discharge information. Nurses in the OR are a differant kind of nurse altogether. I now am working in the ER, and that utilizes all of the skills I learned in nursing school such as injections, starting lines, nasogastric tube insertion, toiletting patients.Nursing school does not prepare a nurse for the OR, now the other way around yes. Working in the OR as a CST helped me very much in the following ways. I knew anatomy, and had seen it first hand ,like the back of my hand. I knew all about drains, I knew and saw the beating heart when a coronary bi-pass was being performed. I saw tendons and bones from the inside out. Even though I was one up on the other students I kept my mouth shut in order not to be a know-it-all. Only one time did an instructor ask me a question about a surgery. I think they resented me for it was a part of nursing that they did not know. I showed them by ranking 2nd in my class, and influenced many other CST's to go to nursing schoo.

0 Votes

Thanks so much for your Pearls of wisdom! Im very much interested in going to OR nursing after I graduate. Can you give advice on how to survive nursing school and what good skills to hone into to be a more efficient OR nurse. I've heard getting critical care experience and med/surg are good skills to have before getting into OR. Any advice is greatly appreciated!

0 Votes

Thank you so much for your awesome interpretation of being an OR nurse. I am a new graduate and got an amazing position at a private outpatient surgery center as a floater OR to PACU ..lots of ortho ..hands feet knees some minor plastics and some ent..mainly ortho.. I was hoping you could give me some good tips so i dont crash and burn. Whoever said it is right they do not prepare you in RN school to do OR. I loved my PACU rotation best but cannot wait to hit the OR I start monday and I am scared to death. So anything you could tell me to help me hit the ground running would be appreciated. Thank you for your great entry!!:D

0 Votes

What a delight to read this article! :) And what perfect timing for me to read it! I am a 2nd year RN student, and tomorrow I get to spend my day in the OR. I have been looking forward to this experience since I found out about it from friends who were in the RN & LPN programs before I began my journey of becoming an RN. After my OR orientation today I was feeling a little nervous about going tomorrow! For the first time I felt like I was going to be sick, and felt so worried that I would inadvertently contaminate something or worse. But reading this article lightened my mood, eased some of my worries, and brought back the excitement!!! :) If only you were the circulating nurse in my OR room tomorrow! I hope whomever the OR nurse is, that she is as willing to share her experience with me as you have been through this article! Thank-you!!!!

0 Votes

I had the most WONDERFUL two days in the OR!!!!! :) I'm already sad that I don't get to go back tomorrow. The staff let me scrub in for one orthopedic surgery... they let me gown and glove the surgeon... and then the surgeon used me as his assistant! It was AMAZING! :)

0 Votes